Provider Demographics
NPI:1538242151
Name:RICHARD COTTRELL DDS PC
Entity type:Organization
Organization Name:RICHARD COTTRELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-775-7671
Mailing Address - Street 1:11060 SMILE WAY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3470
Mailing Address - Country:US
Mailing Address - Phone:540-775-7671
Mailing Address - Fax:540-775-0626
Practice Address - Street 1:11060 SMILE WAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3470
Practice Address - Country:US
Practice Address - Phone:540-775-7671
Practice Address - Fax:540-775-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty